Unexpected fatal right ventricular rupture during liver transplantation: case report.

BACKGROUND: The pulmonary artery catheter provides most hemodynamic informations, which are necessary for the patient monitoring during liver transplantation. However, its application may be associated with complications. CASE REPORT: Authors present a case of unexpected right ventricular rupture during liver transplantation in a 53-year-old male, with end-stage liver disease secondary to hepatitis C virus and alcohol abuse. The most likely cause of this complication was myocardial scarification of right ventricle during introducer sheath inserting. There was six hours period between vessel cannulation and the first signs of heart failure, which occurred in the final anhepatic phase. Attempts to surgical repair of damaged heart wall failed and the patient died. CONCLUSIONS: Based on the present case analysis we suggest to restrict the introduction depth of dilatator and possibly shorten it 2-3 cm by the manufacturer. We should also note that time elapsed from the vessel cannulation to cardiac tamponade first signs does not preclude this procedure as a cause of this fatal complications.